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15020107I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10268 ORANGE AVE I CONTRACTOR: I PERMIT NO: 15020107 OWNER'S NAME: LEE ROLAND L AND SHU L OWNER'S PHONE: 4083904941 ❑/ LICENSED CONTRACTOR'S DECLARATION License Class___ Lie. #f/ Contractor Iy I �ty j3f/. c� G�-ACS Date 5IiaO t j I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point rce regulations per the Cupertino Municipal Code, Section 9 18. _ /natu Date /001 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. Date DATE ISSUED: 02/18/2015 PHONE NO: (408) 615-1850 BUILDING PERMIT INFO- BLDG F ELECT r— PLUMB f MECH r RESIDENTIAL F— COMMERCIAL r JOB DESCRIPTION REMODEL (E) KITCHEN (100 ST), REMODEL 3 (E) BATHS (140 ST) & REPLACE POST IN GARAGE Sq. Ft Floor Area: I Valuation: $70000 APN Number: 35719117 00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of App Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Ad ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed L 1284.4 @EJL Roland Lee 10268 Orange Ave 'Cupertino, -CA'96014 April 30, 2015 City of Cupertino Building Department To Whom It May Concern, This letter is to inform you that Alfa Builders is no longer the contractor far our remodel project at 10268 Orange Ave. The new contractor for our project is Folkers Builders, /, r X& f `11 t Sincerely, Boland Lee 408-390-4941 I �d CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10268 ORANGE AVE CONTRACTOR: ALFA BUILDERS CO PERMIT NO: 15020107 OWNER'S NAME: LEE ROLAND L AND SHU L 650 CLARA VISTA AVE DATE ISSUED: 02/18/2015 OWN'S PHONE: 4083904941 SANTA CLARA, CA 95050 PHONE NO: (408) 615-1850 JOB DESCRIPTION: RESIDENTIAL � COMMERCIAL LICENSED CONTRACTOR'S DECLARATION REMODEL (E) KITCHEN (100 S.F.), REMODEL 3 (E) License Class _ Lic. # 'D � BATHS (140 S.F.) & REPLACE POST IN GARAGE oll D /` Contractor 'tel conol`` —Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $70000 I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, r the performance of the work for which this APN Number: 35719117.00 Occupancy 7�ype: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LA ' ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, the t S costs, and expenses which may accrue against said City in consequence of I Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. � Signature c / Date RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: _ I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this p C Owner or authorized agent: i �1% `%��_ Date: permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO M CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(ftupertino.org I-1 I I AI 'MD ATTnXT / TT I I DT71JTeT"XT / nUVWDDT:TI (1DTf:T11,TAI PI V WAIT 1! PROJECT ADDRESS 7 / p APN I OWNERNAME O\ V\ _I PHONE �h� LSO _ { I (� VC IcA1 E-MAIL rc> a VX but d. C, [- STREET ADDRESS 104 0(� / �K D C -Q CITY, STATE, ZIP`a / FAX ! D pt CONTACT NAMEE-MAIL` /� n r STREET ADDRESS (rte r(1 1[, /y �p 1 j `* V❑1 CITY, STA II Cc n r� /*� FAX / OWNER ❑ OWNER -BUILDER OWNER AGENT Q CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRA[ 1 EN,M LICEN�v('TYPE BUS. LIC # 3 6 0 2 COMPANYAM W(C&12" S Lo E-MAIL • ► f 1 W STREET ArS n' (, [TTY, 'ATV �' V� '� P Pwa ARCHITECT/ENGINEER NAME LICENSE NUMBBEEjR BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE 11S' 113RES USE TYPE OCC. SQ.FT. VALVA"PION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM REMODEL AREA / KITCHEN O REMODEL AREA tREMODEL OTHER AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH N DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? ONO SECOND STORY ❑ YES ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL H ❑ NO PLANNING APPROVAL LETTER IS THE BLDGAN YES V EICHLER HOME? _ _ - TOTAL V ALT IATION: O 00 By my signature below, I certify to each of the following: I am the property owner ora prized agerTto act on erty owner's behalf.- I have read this application and the information I have provided is correct. I have read the Description of Work arrs accurate. I agree to comply with all applicable local ordinances and state laws relating to building constructi I authorize resen e f Cupertino to enter the above-identiifi property for inspection purposes. Signature of Applicant/Agent: Date: 144 a /T SUPPLEMENTAL INF TION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD 11PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH Bldg4pp_2011.doc revised 06/21/11 It "Co/ ��.,�, CITY OF CUPERTINO �1 FF.F. F,CTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n-f—"i of, ► Thoco fooc oro hacod nn rho nr,,Hjninary infarmatian availahlo and are nnlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) ADDRESS: 10268 ORANGE AVE DATE: 02118/2015 REVIEWED BY: MELISSA MISC ITEMS APN: 35719117 ''Iatmn, Permit I't'.': BP#: Q ?tftcr ;Lfern, Ins,; -VALUATION: 1$70,000 *PERMIT TYPE: Building Permit n. las/=. F1'e PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PME Plan Check: $0.00 = s.f. $645.00 PENTAMATION 1R3SFDREM PERMIT TYPE: WORK REMODEL E KITCHEN 100 S.F. , REMODEL 3 E BATHS 140 S.F. & REPLACE POST IN SCOPE GARAGE $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n-f—"i of, ► Thoco fooc oro hacod nn rho nr,,Hjninary infarmatian availahlo and are nnlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS tcch, Per>nit Fee: ''Iatmn, Permit I't'.': $0.00 ?tftcr ;Lfern, Ins,; Curt; r .p atml> hasp,LJ I n. las/=. F1'e Pl arnfi b sf:..7 ec> ff'fec. 7 r:, . Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n-f—"i of, ► Thoco fooc oro hacod nn rho nr,,Hjninary infarmatian availahlo and are nnlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F__100_1 s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: 0 Reg. ® OT 0.0 lirs $0.00 PME Plan Check: $0.00 = s.f. $645.00 Remodel, Bath (<=300 sf) IREMRESBAT Permit Fee: Hourly Only? 0 Nes (E) No $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'onstruction TCU" tintinistrari e 1 ('t': 4 0 Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure E) I reivel.Documentcation l° i'e's: Strong Motion Fee: 1BSEISMICR $9.10 =hrs $143.00 Inspections ISTINSP 7 Inspection, Hourly 31dg Stds Commission Fee: 1BCBSC S3.001 SUBTOTALS: $12.101$1,433.001 TOTAL FEE: 1 $1,445.10 Revised: 02/14/2015 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: /0;96V- PERMIT # 15020 OWNER'S NAME: PHONE # D c-( Z GENERAL CONTRACTOR: �' vt� BUSINESS LICENSE # ADDRESS: 6 6 �, C� '�' �/ . CITY/ZIPCODE: �., c�� C qW *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date Owner / Contractor Signature Date 3 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical �P 6 —7 i 3 Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date 3 7 CUPERTINO WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.orq Owner Name R6 t C-� L -C Permit No. 150 9c) ( 07 Address NAC Jr PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION Please refer to the attached California Civil Code Sections 1101.1— 1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: '�(No Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form Owner' Signature: 5(No Go to Question 3. Date: 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: No Go to Question 4. Date: 4. Is ur real property built and available for use or occupancy on or before January 1, 1994? No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: es My real property is built and available for use or occupancy on or before January 1, 1994. — / Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. COY My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB40 7 2014. doc revised 03/18/14 On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). Blfc, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures have been replaced with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and Califomia Green Building Standards Code, and manufacturer's installation requirements, and that the Nvater-conservinglunibin fixtures comply with the requ'remen s i ted in the table below. Owners (or Owner Agent's) Signature: 1— Date: - Upon completing and signing this Certificate, please return it to the Building Division nn order to final your permit. If the existing plumbing fixture water usage/flow rate is equal to or lower Tuan the tlgure snown, it is not requirea to be upgraaea. SB4072014.docrcvdsed 03/18114 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture! (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 Water Usage 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 !Flow Rate Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush:volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be Inoperation at a time, Faucets— Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 sl Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction, other means may be used to achieve reduction. If the existing plumbing fixture water usage/flow rate is equal to or lower Tuan the tlgure snown, it is not requirea to be upgraaea. SB4072014.docrcvdsed 03/18114 CUPERTINO Address SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(5cupertino.org PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwellinc, units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: h -i dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: /la Sinature.. .. ..... —...................................................................... Date:!..4�.� ContractorName: r...�. Signatu ...... ................................................. Lic.# ....l,J..!V..Y.. .... Date: Smoke and COform.doc revised 03/18/14 LTJ